| NPI | 1265665848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-07762) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM m-67045) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2011-11-21 |